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In this new informative capsule, we talk to Beatriz Romero, dental hygienist and mother of a child with Cystic Fibrosis. Beatriz is a dental nurse, as she is known in the United Kingdom, or a dental hygienist, as she is called in Spain.
She is the mother of a child with cystic fibrosis and, therefore, has taken an interest in how oral infections affect people with cystic fibrosis.
Relationship between CFTR protein and dental hygiene
The CFTR protein, which causes cystic fibrosis, is responsible for the formation of enamel.
As we know, the secretions in the body of a person with CF are thicker. Saliva is a secretion that protects the teeth and helps eliminate harmful microorganisms, and it is also affected. CFTR can cause a reduction in saliva production or its composition, which can alter its pH.
Effects of Kreon in the mouth
When we talk about babies with CF who take pancreatic enzymes (Kreon) in granules, they enter the body without the protection of the capsule, which allows Kreon to be absorbed in the digestive tract and not in the mouth.
If these granules remain in the mouth, they can cause mouth ulcers. If there is also a lack of saliva, this problem occurs more easily. At this age, most babies are breastfed, so it is also important to clean the nipple so that no granules remain that could then be ingested by the baby.
In addition, most medications that babies can take are in syrup form. Syrups usually contain sugar or derivatives to improve their taste, so even though they don’t have teeth, they affect the biofilm or biota in our mouths.
Taking antibiotics or inhaling medications facilitates the appearance of candida-type fungi. Oral candidiasis can be detected by a characteristic odor and white spots in the mouth. Therefore, cleaning the mouth with gauze and saline solution after each dose of antibiotics or inhaler use is ideal. The spacer helps eliminate part of this problem, but not entirely.
One of the recommended ways to administer Kreon in the United Kingdom is to mix it with a little homemade apple sauce (about the size of a pea), which has a more acidic pH and protects the granules until they reach the digestive tract, and saline solution to rinse the mouth.
Oral hygiene in people undergoing pre- and post-transplant procedures
For people undergoing transplantation (pre- and post-), good dental hygiene is very important. One of the problems detected is these people’s reluctance to go to a dental clinic due to the possibility of catching infections, which is why many do not visit their dentist, which can be a problem.
The use of high-fluoride toothpaste, oral irrigators, and dental floss is essential, since during the transplant process, these individuals will have a weakened immune system and will also undergo intubation, oxygen masks (which dry out the mouth and eliminate saliva), etc. Therefore, oral hygiene prior to the transplant process will prevent future infections.
Periodontal pockets contain bacteria and can cause gingivitis and periodontitis, meaning that the infection reaches the inner part of the tooth and can no longer be cleaned with a toothbrush. Therefore, the mouth becomes a source of infection that can carry these bacteria to the rest of the body.
Toothbrush sterilization
It is also advisable to sterilize your toothbrush, just as you would with respiratory physiotherapy equipment.
Cross-infection with cohabitants
Beatriz emphasizes that people who live with individuals with cystic fibrosis must also take extra care with dental hygiene, among other things, because they can also share oral bacteria.
Mouthwashing (Rinsing)
Regarding mouthwash, Beatriz advises against using mouthwash or brushing your teeth immediately after inhaling medication (water is fine), as saliva needs to regulate the pH of what is left in your mouth before brushing or rinsing.
In addition, she indicates that mouthwash should be a backup plan when a person cannot brush their teeth, and not used after brushing. In fact, she recommends not rinsing your mouth too much after brushing to allow the fluoride in the toothpaste to take effect.
So much so that it is also recommended that, before going to sleep, we put toothpaste on our finger and spread it around our mouth to improve oral hygiene.
Further information on oral hygiene and cystic fibrosis
Beatriz Romero has provided us with a document that explains in greater detail everything related to oral hygiene and its relationship with cystic fibrosis. You can read it here.
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